An increased risk of violence against child protection workers
and doctors could prevent many of them entering the professions,
raising doubts over the safety of vulnerable children.

As one paediatrician said when questioned in a recent survey: “This
will be the last generation of doctors prepared to do child
protection work. All the specialist registrars I have met have no
intention of following us down this painful road.”

The recruitment crisis in child protection, which has led to an
estimated 30 per cent of designated child protection doctor posts
being unfilled, can be traced back to the fear of recriminations
that makes the work and the road travelled so “painful” for
professionals.

A survey by the Royal College of Paediatrics and Child Health
(RCPCH) of 4,000 practising or recently retired paediatricians
found nearly 14 per cent reported that they had been subject to
complaints related to child protection (news, page 13, 11 March).
And 29 per cent of doctors who had been subject to a complaint said
it had affected their willingness to become involved in potential
child protection cases.

Of all the complaints detailed in the survey and investigated
either locally by independent review or the General Medical
Council, only 3 per cent were upheld. Of the complaints considered
by the GMC 41 per cent were dropped and 59 per cent were found not
proven. None of the complaints were upheld by the GMC despite
rigorous investigations.

But the negative publicity surrounding these investigations has
“destroyed hard-earned reputations based on years of experience”,
researchers conclude. Professor Alan Craft, president of the RCPCH,
says: “We have to try to turn the tide of public opinion. Everybody
worries that if you get involved in this area of work you will end
up reported to the GMC. It’s a lot of pressure on you and your
family. I think that a lot of it is down to the media. Doctors are
not there to be pilloried.”

Craft fears that children will die if the situation does not
improve. He supports better training for junior doctors in dealing
with the stressful situations the work throws up and a cultural
change that brings an end to the scapegoating of doctors.

He says: “Just being aware that doctors are under siege will make
people realise that if we are going to protect children we have to
stop criticising doctors. The 29 per cent of paediatricians who
said that they were reluctant to get involved in child protection
will still be involved. It’s the trainees coming into the
profession who don’t want to become involved at all.”

An unpublished survey of professionals involved in child protection
work, carried out by the British Association for the Study and
Prevention of Child Abuse and Neglect (Baspcan), paints an even
bleaker picture. The study involving nearly 300 professionals, half
being social workers and paediatricians, found 31 per cent had
experienced physical assaults, some involving weapons, with 8 per
cent having been assaulted in the previous year.

Some 67 per cent had experienced threats of violence during their
careers and 77 per cent had been intimidated.

One professional recounted: “One man said that if his children were
not returned to his care following the final hearing he would visit
my home and shoot me and my family.” Others told of how they had
been threatened with an axe or a gun, or attacked with scissors and
a knife. One worker was “knocked out” and kept prisoner in a house
for two hours by the father of an emotionally abused child, another
was stalked by a man after appearing as an expert witness.

The authors of the report into the Baspcan survey, Dr Lorna Bell
and Jonathan Picken, recommend that social services departments and
health care trusts start to recognise the impact of violence,
threats and intimidation on staff and their capacity to protect
children. Supportive supervision should also be provided to
professionals engaged in child abuse work.

Bell says many professionals reported feeling very vulnerable and
alone. “It’s a complicated area of work and professionals have this
pressure on them that they have to get it right every time. Social
workers have supervision for their cases but they don’t tend to be
asked how the cases have left them feeling.”

Things are gradually improving as child protection becomes the
responsibility of everyone involved in children’s lives and not
just designated consultants or specialists.

The Children Bill includes duties on strategic health authorities,
primary care trusts and NHS trusts to safeguard and promote the
welfare of children. Health bodies will have to co-operate with
councils and sit on statutory local safeguarding children boards,
which will replace area child protection committees and be
responsible for ensuring the effectiveness of services.

In January it was announced that mental health trusts, acute trusts
and PCTs will have to meet a new performance indicator on child
protection. The indicator for the 2003-04 star ratings will require
trusts to comply with recommended child protection systems and
procedures. The RCPCH has also drawn up plans for all new
paediatricians to receive one day’s mandatory child protection
training by 2005.

But none of the 1,050 quality indicators in a new GP contract to be
introduced in April covers child protection. GPs and their
practices will be rewarded according to how many points they
receive in each of the areas covered by the indicators, so they
will have no incentive to deal with issues not covered.

Dr Ruth Bastable, a spokesperson for the Royal College of General
Practitioners (RCGP), admits that child protection work is
particularly difficult for GPs because of the trust that is
inherent in the relationship between patient and doctor. GPs are
making progress in the area, she adds, and she has noticed that her
colleagues are “much more willing to talk and think about the
issue”. GP and chairperson of the British Medical Association’s
community care committee, Dr Andrew Dearden, says there is still a
long way to go. He agrees that GPs are reluctant to become involved
in child protection because they are worried about “getting it
wrong”, but he also blames a lack of resources.

Marcia Whitehall-Smith, child protection adviser for children’s
charity NCH, believes part of the answer is multi-agency training
so that social workers, GPs and hospital doctors understand each
other’s roles.

She hopes that new statutory duties on partnership working in the
Children Bill will make life easier for professionals. “When you’re
a consultant you are expected to know all the answers and that
means everyone coming to you. But the Children Bill states that you
have to come at it from a team perspective, comprising doctors,
social workers, police and probation. Then we could lose this idea
that parents can pick off individuals and say ‘it’s the consultant
who said that’ and the idea that other professionals leave it up to
the consultant to decide.”

Under siege

Intimidation experienced by professionals is taking its toll. In
their own words…

“The violent and abusive father of children who were taken into
care threatened the social worker and other professionals involved
in the case with death. I felt quite threatened.”

“In my case I was verbally threatened, as were my children, to the
extent that the police were involved.”

“I have been physically assaulted in court, threatened with
assault, verbally assaulted, spat at and locked in the house by an
angry client and not allowed to leave.”

“This past 12 months have made me feel awful and I wonder for how
much longer I am willing to stand up in court to defend children
given the violence, threats and intimidation I have received.”

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